WHAT started out as a bold step to address the issue of Human Immunodeficiency Virus-Acquired Immune Deficiency Syndrome (HIV-Aids) in Davao City is now evolving as a treatment hub for HIV-Aids in Mindanao.
For years now, the City's Reproductive Health and Wellness Center (RHWC) has focused on encouraging people with high-risk sexual behaviors to come over and be tested, so that HIV can be detected at an early stage and corresponding treatment can be offered to those infected.
But the center's success in encouraging people to be tested has drawn others from outside Davao City to seek their assistance as well.
Thus, another program that seeks out prospective persons with HIV in the communities is on a pilot stage. The program, aside from ensuring that more people in high-risk lifestyles are enticed to be tested, will also screen out the negatives right within the communities.
RHWC head Jordana Ramiterre said that early determination of "reactive" and "non-reactive" would ease the burden of the number of clients they have in the center. This is possible through their Community-Based Screening (CBS).
In the CBS, motivators, or those trained personnel who go around with blood test kits in communities, for confirmatory tests in the RHWC those who are reactive in the screening, meaning the initial on-site test indicates possible positive status.
CBS, a pilot program
The CBS motivators are deployed to areas where HIV-positive persons frequent or live in.
In Davao City, it is the RHWC that implements the program, with funding from the Department of Health (DOH) and the Global Fund.
CBS motivator Alex C. Niegas said that through CBS, clients are given options on how they can be tested.
The program addresses various stumbling blocks for a person to submit himself to a test: the distance of RHWC from their homes, the shame of seeking assistance from the RHWC, and the stigma of being identified as an HIV-Aids "candidate."
Methods in offering CBS
“Every time we go to a community, we always encourage them first to be tested in our testing center, if they will say yes, then we will not conduct CBS, because it means he is not hard to reach. Once the client will say, 'I cannot because I am ashamed' or 'I cannot go because I return late at home from work,' that is when we offer CBS,” Niegas said.
Those who refuse to be tested at the center are offered on-site testing through CBS. It can be done at the prospect's home, in a lodging house, or anywhere the prospect feels comfortable to be pricked for blood sample.
"As long as it is an area where they can be comfortable and as long as it is also safe from the ears and eyes of people. Everything is confidential," Niegas said in the vernacular.
He said they always introduce themselves as from RHWC and they wear proper identification cards.
Conducting the test on-site is done with careful attention on strict sanitation because of the likelihood that they are drawing contaminated blood.
Niegas is one of more than 20 CBS motivators in whole Davao City. He started as a volunteer peer educator who was later absorbed by the local government unit.
But since the CBS is still on pilot stage, Ramiterre said they can only know if it is effective after a period.
She said modules for the motivators were developed starting 2014, and the training was done in 2015.
Ramiterre said they can only select a few persons for the CBS, as the screening and pricking conducted by lay people without medical educational background has once caused an issue with Philippine Association of Medical Technologists (Pamet), because such job should be done by the medical technologists.
“Nagkaroon ito ng malaking debate before it was even allowed. Of course, ang mga experts sa medical technologists, marami ang issues na nag-arise,” she said.
Ramiterre said that provisions of the program were carefully laid down first before it finally got the go-signal for pilot implementation.
The peer educators
Aside from CBS, RHWC has been doing its extensive information drive on HIV-Aids prevention.
This information drive, which has been going on for years now, could be among the reasons that many Dabawenyos are encouraged to take tests and there is a high number of confirmed cases in the city.
From January to November 2016, Davao City has recorded a total of 345 confirmed HIV-Aids, with 56 full-blown cases.
Ramiterre said that though discrimination and stigma on HIV are still major barriers, these do not stop them from providing the needed services.
"Hindi lang prevention and control and ngayon treatment nasa RHWC. We also have a training program and we have trained different areas sa Davao City regarding sa HIV-STI (sexually transmitted infection) orientation, voluntary counseling, and testing. Meaning to say, we are capacitating other health personnel in our office," she said.
At present, the RHWC employs 60 peer educators headed by site implementation heads.
For monitoring of their peer educators, the site implementation head who handles 10 to 12 peer educators conducts focus group discussions, learning group sessions and updating.
These peer educators are mostly MSM or male having sex with males, which reportedly recorded the highest number of cases of HIV population. They designed it to be so for greater sensitivity to the issue on hand.
“The peer educators themselves are our gateway to MSM because they themselves are MSMs. Siyempre alam nila ang activities and personalities, ano ba ang nangyayari sa isang community. Alam yan ng peer eds [they are very helpful in this aspect] because that is the only way we can link our services to key populations,” Ramiterre said.
Ramiterre added that they also need to classify the peer educators to address the diversity of MSM population.
“May mga discreet groups, may bisexual, purely homosexual, mayroong straight, you never know. 'Yun kasi ang mahirap sa HIV kasi hindi nilalantad ng tao kung ano siya in terms of sexual preference, kaya yung dapat yung peer ed namin by classification din,” she said.
It's not just information dissemination, she said, but treads on various moral and ethical issues.
She also said that they assign the peer educators in strategic areas identified in the Integrated HIV Behavioral and Serologic Surveillance (IHBSS).
Aside from the peer educators, district health centers are also active in pushing the HIV-Aids campaign.
Ramiterre said that 17 health districts within the city also refer those who were screened to be reactive.
Jeff Fuentes, city population officer, said HIV prevention is among the lecture topics included during the pre-marriage counseling, and lectures in Men’s Responsibility to Reproductive Health.
He said the City Population Office is closely coordinating with universities and high schools in conducting seminars and symposiums for STI-HIV-Aids.
Two years ago, guidance counselors of seven schools were trained with the Adolescent Job-Aid manual, which allows them to detect different behavior of adolescents, which is also helpful in HIV prevention.
These guidance counselors are advised to work hand in hand with student peer educators.
Fuentes stressed that proper identification and sensitivity of the messages of the youth is a must. As example, he cited that 70 percent of youth who are still categorized as not sexually active must be taught abstinence, while 30 percent who are sexually active must learn secondary abstinence and proper condom use.
“The perception of condom as attached to something bad and promiscuous sexual practice must be changed and rather be seen as a protection and health care investment to the young generation,” he said, adding that flooding of information should eradicate the phobia of condoms.
Fuentes urged the Department of Education and Commission on Higher Education to be vigilant in implementing the Philippine Aids Prevention and Control Act of 1998 (Republic Act 8504).
Bottomline: prevention is always better than a cure.